The contribution of Mycoplasma genitalium to the aetiology of sexually acquired infectious proctitis in men who have sex with men.

This study examined the contribution of Mycoplasma genitalium to sexually acquired infectious proctitis in men who have sex with men (MSM). MSM with symptomatic proctitis between May 2012 and August 2013 were tested for rectal sexually transmitted infections including chlamydia, gonorrhoea, herpes simplex virus (HSV) and M. genitalium. The load of rectal M. genitalium in men with symptomatic proctitis was compared with a separate group of men who had rectal M. genitalium but no symptoms of proctitis. Among 154 MSM with proctitis, rectal M. genitalium was detected in 18 men (12%, 95% CI 6.9-17.1) and was significantly more common among human immunodeficiency virus (HIV) -positive men (21%, 95% CI 9.5-32.6) than HIV-negative men (8%, 95% CI 2.9-13.1; prevalence ratio 3.2, 95% CI 1.2-8.8). Among HIV-positive men the detection of M. genitalium was comparable to that for chlamydia (21%, 95% CI 9.5-32.5), gonorrhoea (25%, 95% CI 16.2-41.8) and HSV (19%, 95% CI 7.9-30.1). Rectal M. genitalium load was significantly higher among the 18 men with symptomatic M. genitalium-associated proctitis than among a separate group of 18 men with asymptomatic rectal M. genitalium infection (60 000 copies of organism/swab versus 10 744 copies of organism/swab, p 0.023). Comprehensive testing for rectal pathogens in MSM with proctitis should include testing for M. genitalium.

Detection of Neisseria gonorrhoeae Isolates from Tonsils and Posterior Oropharynx.

We examined the factors influencing gonorrhea detection at the pharynx. One hundred men infected with Neisseria gonorrhoeae were swabbed from the tonsils and posterior oropharynx. N. gonorrhoeae was reisolated from the tonsils and posterior oropharynx in 62% and 52%, respectively (P = 0.041). Culture positivity was greater with higher gonococcal DNA loads at the tonsils (P = 0.001) and oropharynx (P < 0.001). N. gonorrhoeae can be cultured from the tonsils and posterior oropharynx with greater isolation rates where gonococcal loads are higher.

Sampling technique is important for optimal isolation of pharyngeal gonorrhoea.

BACKGROUND: Culture is insensitive for the detection of pharyngeal gonorrhoea but isolation is pivotal to antimicrobial resistance surveillance. The aim of this study was to ascertain whether recommendations provided to clinicians (doctors and nurses) on pharyngeal swabbing technique could improve gonorrhoea detection rates and to determine which aspects of swabbing technique are important for optimal isolation. METHODS: This study was undertaken at the Melbourne Sexual Health Centre, Australia. Detection rates among clinicians for pharyngeal gonorrhoea were compared before (June 2006-May 2009) and after (June 2009-June 2012) recommendations on swabbing technique were provided. Associations between detection rates and reported swabbing technique obtained via a clinician questionnaire were examined. RESULTS: The overall yield from testing before and after provision of the recommendations among 28 clinicians was 1.6% (134/8586) and 1.8% (264/15,046) respectively (p=0.17). Significantly higher detection rates were seen following the recommendations among clinicians who reported a change in their swabbing technique in response to the recommendations (2.1% vs. 1.5%; p=0.004), swabbing a larger surface area (2.0% vs. 1.5%; p=0.02), applying more swab pressure (2.5% vs. 1.5%; p<0.001) and a change in the anatomical sites they swabbed (2.2% vs. 1.5%; p=0.002). The predominant change in sites swabbed was an increase in swabbing of the oropharynx: from a median of 0% to 80% of the time. CONCLUSIONS: More thorough swabbing improves the isolation of pharyngeal gonorrhoea using culture. Clinicians should receive training to ensure swabbing is performed with sufficient pressure and that it covers an adequate area that includes the oropharynx.

Differing Neisseria gonorrhoeae bacterial loads in the pharynx and rectum in men who have sex with men: implications for gonococcal detection, transmission, and control.

The bacterial loads for gonococcal infections of the pharynx and rectum were determined among men with male sexual partners. The median bacterial load for rectal infections (18,960 copies/swab) was significantly higher than the load for pharyngeal infections (2,100 copies/swab; P = 0.001). Bacterial loads among men with symptomatic proctitis were strikingly high (median, 278,000 copies/swab).

Delay in the diagnosis of early syphilis among men who have sex with men: need for greater community and health provider education.

The objective of this study was to determine the duration between onset of symptoms of early symptomatic syphilis and diagnosis among men who have sex with men (MSM). A review of cases of primary and secondary syphilis among MSM presented to the Melbourne Sexual Health Centre between January 2003 and August 2007. The mean age of the 123 MSM included was 37 years. Fifty-two percent (n = 64) presented with primary syphilis and 48% (n = 59) with secondary syphilis. Twenty-five percent were HIV-positive. The median rapid plasma reagin titre was 1:32. Of the 34 men referred by general practitioners, referring practitioners did not consider the diagnosis of syphilis in 10 cases of primary syphilis and 20 cases of secondary syphilis. For primary and secondary cases combined, the median duration between onset of symptoms and diagnosis, and onset of symptoms and treatment, was 15 (3-56) and 20 (1-57) days, respectively. The respective durations for secondary syphilis (17 and 23 days) was longer than for primary syphilis (13 and 15 days) (P < 0.05). The mean number of sex partners reported for the prior three months was 8.8 (range 1-15). If early detection and treatment of syphilis is to be optimized in order to improve syphilis control, greater awareness of its symptoms and signs of syphilis need to be promoted among both health-care providers and affected communities.

Acute hypoglycaemic coma--a rare, potentially lethal form of early onset Sheehan syndrome.

This case emphasizes the importance of intensive obstetric management that is required when confronted with prolonged postpartum haemorrhage. Anticipation of the possibility of acute hypoglycaemic coma as an initial manifestation of Sheehan syndrome and prompt recognition may prevent disastrous consequences, including maternal death.